| Objective:To analyze the variations of the plasma level of vascular endothelial growth factor (VEGF) and matrix metalloproteinases(MMPs) in hepatocellular carcinoma patients after transarterial chemoembolization combined with infusion of endostar.Materials and methods:1. 56 patients with advanced hepatocellular carcinoma were equally and randomly divided into study group(n=28) and control group(n=28).All patients were diagnosised according to the clinical diagnostic criteria for advanced hepatocellular carcinoma or confirmed by the histopathology.2. Patients in study group received intrahepatic arterial infusion of rh-endostatin together with TACE,while patients in control group received conventional TACE only.3. Observation indicators:①Peripheral blood samples were collected preprocedure and on d3,d7,and 28d postprocedure.Plasma VEGF and MMPs levels were detected by the quantitative sandwich enzyme-linked immunosorbent assay(ELISA).②The dual-phase enhanced CT, MRI images were performed 1 week before procedure and 1 month after the procedure. All typical target lesions of the liver were measured, ,the maximum activity in diameter was calculated and reported as the sum of the longest diameter (SLD), to study the postprocedure responses of the target lesion with modified HCC RECIST criteria;③Peripheral blood samples were collected preoperatively and on d28 postoprocedure.Plasma AFP level was measured by the immunofluorometric assay.④The observations of the complications of TACE were recorded. The survival time after the first TACE were followed in all patients.Results:1.Serum VEGF and MMPThe preprocedure serum VEGF and MMP of the study group were12.53±4.81pg / l, 6.43 ±2.85pg / l respectively, while the control group were 12.74±6.18 pg / l, 7.09±1.60pg / l respectively. The difference of the preoperative VEGF, MMP was not significant. The serum VEGF levels of the study group on 3, 7, 28 days postprocedure were 12.58±4.89,12.75±4.87,12.36±1.48pg / l respectively, the difference of serum VEGF between preprocedure and postprocedure levels was not significant. The serum VEGF levels of the control group on d 3, d 7, d28 postprocedure were12.74±6.18,13.01±6.29,12.57±6.1pg / l respectively. Plasma VEGF level was elevated on 7 days postprocedure compared with preprocedure level ( P <0.05). The difference was not significant on 3 and 28 days postprocedure compared with preproceduree level.The serum MMP levels of the experimental group on 3, 7, 28 days postoprocedure were 6.53±2.85,6.46±2.79,6.45±2.66pg / l respectively, the difference of serum MMP between preprocedure and postprocedure levels was not significant. The serum MMP levels of the control group on 3, 7, 28 days postprocedure were 6.97±1.49,7.39±1.56,7.1±1.73pg / l respectively, plasma MMP level was elevated on 7 days postprocedure compared with preprocedure level ( P <0.05). The difference was not significant on 3 and 28 days postprocedure compared with preprocedure level.2. The changes of serum AFP.26 in 28 patients of the experimental group were AFP-positive while 24 in 28 patients were AFP-positive in control group. The preprocedure serum AFP of each group were 601.28±372ng/ml, 800.52±190.34ng/ml respectively. The difference of the preprocedure AFP was not significant (P>0.05). The serum AFP levels of the two groups between 3 to 4 weeks postprocedure were 606.28±332.76ng/ml, 656.02±313.19ng/ml respectively.The difference between the two groups was not startiscally significant(P>0.05).3. The response of the target lesion .28 patients in study group were performed 50 procedures with PR in16 patients( 32%), CR in 18 patients(36%), SD in 14 patients(28%), PD in 2 patients(4%). Total effectiveness rate (PR + CR + SD) was 96%. While in the control group, 28 patients were performed 51 procedures. with PR in 16 patients(32.3%), CR in 8 patients(14.7%), SD in 16 patients( 32.3%), PD in 11 patients(20.7%). Total effectiveness rate (PR + CR + SD) was 79.3%.The total effectiveness rate of the study group was higher than the control group. The difference between the two groups was startiscally significant(P<0.05). 4. The response of liver-function and changes in ECOG score28 patients in study group were performed 50 procedures with improved liver function in 15 procedures, no change in the 25, down in 10 procedures; with improved quality of life : 4 procedures, no change in 38,down in 8 procedures. While in the control group were performed 51 procedures with improved liver function in 7 procedures, no change in the 26, down in 18 procedures; with improved quality of life : 12 procedures, no change in 13, down in 26 procedures. The results showed that liver-function of the study group is better than the control group, two groups of patients are no significant difference in the quality of life.5.The complications and survival time after TACE procedure.According to the results of follow-up ( end time of the follow-up :2011-5-1), there was no increase in side effects of the study group, and no adverse event correlated with rh-endostatin. The average postprocedure survival time of the study group is 250 days, the shortest survival time is 34 days; The average postprocedure survival time of the control group is 214 days,the shortest survival time is 67 days.Conclusion:1. Dynamic detection of plasma VEGF,MMP levels in two groups of HCC patients reflected the inhibitory effects of rh-endostatin on the plasma VEGF,MMP levels.It provided indirect evidence that rh-endostatin had inhibitory effects on tumor angiogenesis at certain degree, and to some extent, prevent invasion of the surrounding normal tissue.2. The therapy on local control of HCC of study group is better than the control group.3. There is no more adverse reactions and complications in study group than the control group, and no side effects occurred correlation with rh-endostatin,It is a safe treatment of TACE combined endostar. |
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